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Profile of children requiring emergency treatment for asthma
1Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Insights
A small group of patients accounts for many emergency visits for asthma. Many of these patients have a history of hospitalization and underuse anti-inflammatory medications, indicating a need for better asthma management.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Healthcare Management
Background:
- Emergency department (ED) visits for asthma are costly and highlight inefficiencies in care continuity.
- Identifying high-risk patients is crucial for proactive interventions to prevent ED visits.
Purpose of the Study:
- To identify factors preceding emergency department treatment for wheezing in children.
- To assess the level of medical care received by patients before ED visits for wheezing.
Main Methods:
- Prospective survey conducted at an academic children's hospital ED.
- Data collected via medical records, phone calls, and letters from January 1, 1994, to December 31, 1994.
Main Results:
- 16% of patients accounted for 36% of 1870 asthma-related ED visits.
- 70% had a family history of asthma; 192 patients had prior hospitalizations for wheezing.
- Underuse of inhaled corticosteroids (16%) and oral corticosteroids (7%) was noted, with frequent use of beta-agonists.
Conclusions:
- A distinct subset of patients experiences recurrent wheezing, necessitating improved management to reduce hospital service utilization.
- Limited follow-up with asthma specialists and underutilization of anti-inflammatory drugs characterize these high-risk patients.
- Targeted interventions are needed to enhance care quality and prevent expensive ED visits for pediatric wheezing.
Background:
Emergency department care for asthma is expensive and continuity of care is often inefficient. Identification of patients-at-risk for emergency treatment is required in order to intervene before visits to the emergency department.
Objective:
To identify the antecedent factors in patients requiring emergency department treatment for wheezing and to determine the level of care before emergency visits.
Methods:
A prospective survey of patients treated for wheezing in the emergency department of an academic children's hospital from January 1, 1994 to December 31, 1994. Data were compiled from a data from completed from the information obtained from the medical record, phone calls and letters.
Results:
During 1994, 1474 patients were treated for asthma and accounted for 1870 visits to the emergency department. Thirty-six percent of the total number of visits were made by 16% of the patients who made repeat visits. Two-thirds of the patients were 5 years of younger. Over 190 patients had been hospitalized for wheezing during the preceding 12-month period. Forty-four percent of the patients were referred to the emergency department by primary care physicians and 6.7% were referred by asthma specialists, either allergists or pulmonologists. The major predisposing factor was a family history of asthma in 70%. Beta agonists were the medications most frequently used prior to the emergency visits. Inhaled corticosteroids were used daily by 16% of the patients and oral corticosteroids were used daily by 7% of the patients.
Conclusion:
Thirty-six percent of the visits were due to 16% of patients who were seen repeatedly in the emergency department for wheezing and a number of patients (192) had been admitted previously for wheezing. These findings suggest that there is a subset of patients who are known to have recurrent wheezing, but lack adequate management to avoid expensive hospital services. Very few of these patients were followed by asthma specialists and there was a marked underuse of anti-inflammatory drugs. This study characterized a subset of patients-at-risk for requiring emergency treatment for wheezing. There is a need to institute aggressive interventions to improve the quality of care and prevent costly emergency department visits.